Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty

Background and Purpose-Percutaneous transluminal angioplasty (PTA) is curre ntly being assessed for the treatment of carotid stenosis. In comparison wi th carotid endarterectomy (CEA), there is evidence of an increased risk of cerebral microembolism during the procedure. We have sought evidence of any neuropsychological sequelae of carotid PTA and compared it with CEA to dem onstrate the relative safety of the 2 treatment options. Methods-The neuropsychological outcomes after CEA and PTA were compared in 2 matched groups of patients with severe symptomatic carotid stenosis, 96% of whom had been randomized in the Carotid and Vertebral Artery Translumina l Angioplasty Study (CAVATAS), at a single center. Transcranial Doppler ins onation of the middle cerebral artery was used to measure cerebral reactivi ty in response to carbon dioxide inhalation before treatment and then to de tect microembolization of the ipsilateral cerebral hemisphere and measure c hanges in blood flow velocity during the procedures. The performance on a n europsychological test battery administered before, 6 weeks after, and 6 mo nths after the procedure was compared in 20 patients undergoing PTA and 26 having CEA, Results-At 6 weeks, 5 patients in each group showed a similar decline in ne uropsychological performance; global measures showed no significant differe nce between the 2 procedures, despite a significantly higher incidence of m icroemboli during PTA. Both groups showed a marked reduction in anxiety aft er treatment, Conclusions-The findings provide some reassurance that PTA is not associate d with greater cerebral complications than CEA, despite the higher embolic load recorded by transcranial Doppler ultrasonography during angioplasty.